Angular cheilitis (perlèche) is a chronic inflammatory condition of the corners of the mouth (commissures) that is usually associated with a candidal or staphylococcal infection. The areas are generally slightly painful. The condition tends to last from days to months, depending on whether the patient seeks treatment. There may be concomitant intraoral candidiasis.
Patients with diabetes mellitus, those who are immunocompromised, and those who have undergone head and neck radiation are prone to develop oral candidiasis, including angular cheilitis.
Patients who wear dentures that do not adequately support the facial musculature are also prone to develop angular cheilitis. Patients will have accentuated folds at the corners of the mouth, leading to wicking of the saliva onto what is normally dry skin. The moist keratin acts as substrate that encourages fungal and bacterial growth.
Patients with iron;vitamin B2, B3, B6, or B12; zinc; or folate deficiencies are predisposed to this condition, although these represent a much less common cause for angular cheilitis.
Related topics: cheilitis, actinic cheilitis, exfoliative cheilitis, granulomatous cheilitis
Angular cheilitis - Oral Mucosal Lesion
Alerts and Notices
Synopsis
Codes
ICD10CM:
K13.0 – Diseases of lips
SNOMEDCT:
266429005 – Angular cheilitis
K13.0 – Diseases of lips
SNOMEDCT:
266429005 – Angular cheilitis
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Herpes simplex virus (HSV) infection – Usually not bilateral as angular cheilitis typically is.
- Lip-licking dermatitis – More diffuse involvement of the lips.
- Secondary syphilis – "Split papules" may affect the angles of the mouth; other signs of secondary syphilis would be present as well.
- Plummer-Vinson syndrome – This severe iron deficiency should also be associated with fatigue, shortness of breath, etc.
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
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References
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Last Updated:07/17/2023
Patient Information for Angular cheilitis - Oral Mucosal Lesion
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Angular cheilitis - Oral Mucosal Lesion